NHS Review To Push For More Nurse-Led Care
The long awaited review into the future of the NHS by Lord Darzi will next week propose a big boost in the size of independent nurse-led provision of primary care, similar in ambition to the rise of independent foundation hospitals.
The government has proposed an expansion of nurse-led services in the primary care sector in the past, but progress has been slow. In an effort to speed up the process, Darzi will suggest that nurse-led partnerships should be given a statutory right to request a local primary care trust to allow them to set up as a not-for-profit trust. If the PCT agrees, this would improve care, and a new independent NHS organisation would be established to provide services to patients, under contract to the PCT, using NHS resources.
Darzi will also propose that nurses transferring from the NHS to a not-for-profit sector should not lose their pension rights, a threat that in the past has held back applications.
Ministers believe nurse-run services have enormous potential to cut bureaucracy in primary care and focus care more directly on the needs of patients.
Darzi, under-secretary of state in the health department, will point to the example of nurse-run services already existing in the NHS, such as Central Surrey Health Partnership, a 600-strong not-for-profit company that has provided community nursing and therapy services since 2006. But ministers admit they have been slow to develop other examples of such independent services in primary care.
Overall, around 150,000 staff work in community health services. Currently just a handful of staff-led social enterprises provide NHS services, but with these new freedoms, the government expects the number to increase significantly. In a foreword to a Cabinet Office report on public services to be published today, Gordon Brown says he foresees a big extension in the role of independent non-profit organisations.
During Tony Blair’s premiership, Brown strongly opposed foundation trusts in the NHS, but after a largely successful battle with the then health secretary Alan Milburn limiting the scale of their financial freedoms, he embraced them, though they remain unpopular with health unions.
In his foreword, Brown writes: “Building on the success of the foundation trust model in the NHS, which sees a million people actively engaging in the governance of their local hospitals, I believe that over the next decade we will see a growing proportion of our services provided by independent public service providers and social enterprises.
“We have only just begun to harness the potential for these kinds of non-profit organisations. In the coming weeks we will set out how we can promote a new wave of innovation led by social enterprise whilst protecting the values of publicly funded services, free at the point of use.” He suggests the NHS constitution, due to be outlined next week as part of its 60th anniversary celebrations, will enshrine universal entitlements to basic standards. When a hospital or other healthcare provider falls below acceptable standards, new powers will be used to turn them around.
In recent weeks ministers have suggested the voluntary or social enterprise sector could play a big role in the provision of job placement, community punishments and, now, in health primary care.
Brown distinguishes his proposals from those of David Cameron by saying he is not proposing “a return to the most vulnerable in our society depending on charity, but a genuine openness to new ways of delivering services to the benefit of all.” Labour believes Cameron’s vision of public services will see many such services handed over to charities and voluntary organisations with inadequate funding, regulation and targets.
In his foreword Brown says the new role for government is to step back, set direction and stand up for citizens against vested interests: “Successful public services worldwide are based on empowered citizens, public service professionals, acting as catalysts for change, and government providing strategic leadership.”
The Cabinet Office wants to see a “far wider development of innovative organisations such as foundation hospitals, city academies and trust schools run at arms length from government, not for profit, with significant scope for staff and professionals to run services directly responding to users and commissioners”.